Regional Inequalities in under-Five Mortality in Nigeria: A Multilevel Analysis of Community Contextual Factors

Sunday Adedini, University of the Witwatersrand
Clifford O. Odimegwu, University of the Witwatersrand
Sasha Frade, University of the Witwatersrand
Dorothy Ononokpono, University of Uyo
Latifat D. G. Ibisomi, University of the Witwatersrand
Micah Katuruza, University of the Witwatersrand
Bob Elwange, University of the Witwatersrand

Substantial regional disparities in childhood mortality exist in Nigeria. Consequently, studies have attempted to investigate the socio-cultural dimension of this. However, much of these have not focused on ecological and community contextual diversities. Using 2008 Nigeria Demographic and Health Survey, we examined the influence of community-level characteristics on childhood mortality in Nigeria. Applying multilevel Cox proportional hazards analysis, results indicate about twofold higher risks of death for children residing in the North-east and North-west regions (HR:1.90,CI:1.35-2.70,p<0.001) compared with children in the South-west. Risks of death were lower for children of mothers residing in communities with a high proportion of mothers attending prenatal care by a doctor (p<0.05); and for children of mothers residing in communities with a high proportion of mothers who had hospital delivery (HR:0.70,CI:0.61-0.81,p<0.05). Results stress the need to focus attention on community-level interventions aimed at improving child survival in the country’s economically and socially deprived communities.